Increased ureagenesis revealing metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT.
Ilse Vanhorebeek, Nazlı Umman Serin, Sascha C A T Verbruggen et al.
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In 30 seconds
This secondary analysis of the PEPaNIC RCT evaluated the effects of early versus late parenteral nutrition (PN) in critically ill children (newborn-17 years) in PICUs. The study found that higher urea/creatinine ratios (UCR) in the first week of early-PN were associated with increased risk of new infections (adjusted OR 1.746) and higher 90-day mortality (adjusted OR 1.432), suggesting metabolic intolerance to enhanced nutrition.
Key findings
- Higher first week maximum UCR was associated with increased risk of new infection (adjusted OR 1.746).
- Lower likelihood of earlier live PICU discharge with higher UCR (adjusted HR 0.745).
- Increased 90-day mortality linked to higher UCR (adjusted OR 1.432).
- Urea concentrations were also higher in early-PN patients throughout the first 11 days.
Why it matters
Understanding the metabolic response to nutritional interventions in critically ill children is crucial for optimizing care. Elevated urea levels may indicate intolerance to enhanced nutrition, guiding clinicians in nutritional support strategies.